Provider Demographics
NPI:1467112276
Name:MASCIOLI, ALISHA SANTA (MED, LAPC)
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:SANTA
Last Name:MASCIOLI
Suffix:
Gender:F
Credentials:MED, LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 WINDY RIDGE LN SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-2429
Mailing Address - Country:US
Mailing Address - Phone:678-800-9986
Mailing Address - Fax:
Practice Address - Street 1:738 WOODLAWN DR NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-4253
Practice Address - Country:US
Practice Address - Phone:770-726-9589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-20
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
GAAPC008421101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health